# Public-option manufacturing for essential generic cancer drugs in shortage

Source: https://onco.cc/ideas/idea-fund-public-option-generic-oncology/  
OnCo record `idea-fund-public-option-generic-oncology` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cheap, essential chemotherapy drugs such as cisplatin keep running short because there is little profit in making them. A publicly-backed non-profit manufacturer would guarantee supply at a fair price.

## Summary

Extend the Civica Rx and California CalRx model to a portfolio of essential oncology generics that repeatedly fall into shortage (cisplatin, carboplatin, methotrexate, fluorouracil, vincristine, etoposide, BCG): a non-profit manufacturer or contracted network with public capital, long-term purchase agreements from hospital systems and national payers, redundant production sites, and transparent cost-plus pricing. Where the public option also supplies low- and middle-income countries through pooled procurement, it addresses global access at the same time. The problem is not scientific; it is a market that rewards exit from low-margin sterile injectables.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A public-option supplier covering the ten most shortage-prone oncology generics eliminates treatment delays attributable to those shortages in participating health systems within three years and holds prices within 20% of the pre-shortage median.
- Rationale: Civica has supplied dozens of shortage-prone hospital generics since 2018 with stable prices; the 2023 cisplatin and carboplatin shortage in the US forced rationing of curative treatment, an outcome that would be unthinkable for a high-margin product. Public options for essential goods are a standard response to thin-market failure.
- Proposed test: Fund one non-profit line for cisplatin and carboplatin with purchase commitments from a consortium of cancer centres, and track fill rates, delays and prices against the national market over two years.
- Maturity: early-clinical
- Actor: policy

## Sources

- Civica Rx: https://civicarx.org/
- CalRx: https://calrx.ca.gov/

## Connected records

- ideas: [A Global Fund for cancer care in low- and middle-income countries](https://onco.cc/ideas/idea-fund-global-cancer-fund/), [Hospital-based CAR-T manufacturing at cost through a public network](https://onco.cc/ideas/idea-fund-public-car-t-manufacturing/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Platinum agents](https://onco.cc/technologies/platinum/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)

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